According to USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., the task force recommends that physicians provide interventions, including education or brief counseling, to prevent the initiation of tobacco use in this group. "You know, as family physicians, we see people every day with significant health problems -- related to tobacco -- who can't quit," said LeFevre. "Most of them started when they were adolescents, and quitting turns out to be very, very difficult."

LeFevre, a family physician from Columbia, Mo., told AAFP News Now that this particular recommendation focuses on prevention above cessation because the return on investment is substantial.

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The U.S. Preventive Services Task Force (USPSTF) is seeking comment on new draft recommendations proposing that physicians provide interventions, including education or brief counseling, to prevent the initiation of tobacco use by school-aged children and adolescents.

According to family physician and USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., evidence shows there are intervention programs, such as the AAFP's Tar Wars program, family physicians can implement to reduce the number of adolescents that become regular smokers.

The draft recommendation will be available for public comment until Jan. 7 at 5 p.m. EDT.

"You know, we can succeed (in limiting the number of smokers) -- and the task force certainly encourages screening and intervention for adults who are smokers to try and get them to quit -- but it is like the old saying, 'An ounce of prevention is worth a pound of cure,'" he said. "And if you look at the report, the task force did find evidence this time in trials that there are some things that can be initiated by a family physician that can reduce the number of adolescents that become smokers. That's the central message: It is possible to help."

According to the USPSTF, tobacco use is the leading cause of preventable death in the United States, accounting for an estimated 443,000 deaths each year, including nearly 161,000 deaths from cancer, 128,000 from cardiovascular diseases and 103,000 from respiratory diseases. Smoking costs the United States approximately $96 billion per year in direct medical costs.

LeFevre said that although it was not one of the programs specifically mentioned in the evidence, the AAFP's Tar Wars(www.tarwars.org) tobacco-free education program is a prime example of the type of interventions that really work to prevent children and adolescents from experimenting with tobacco. Through Tar Wars, family physicians and other health care professionals present anti-smoking information to fourth- and fifth-graders. More than 9 million children have seen the presentations since the program's inception in 1988.

"The task force found evidence that there are programs that can be initiated by family physicians that will help adolescents not start smoking," said LeFevre. "I think that's a simple message, and I think Tar Wars meets the criteria (set out by the task force in the recommendation).

"Good examples of interventions that worked included print materials, such as those offered by Tar Wars -- activity guides and individual newsletters, tip sheets -- things that are targeted to be sent out to adolescents. I think that this recommendation piggybacks very nicely on the Tar Wars program and is an example of a program that a family physician might endorse and participate in to help in that effort."

In the draft, the USPSTF noted that research gaps exist because few rigorous trials have been done to "examine the effectiveness of primary-care-relevant interventions --behavior, medication or complementary medicine -- to prevent the use of tobacco or to promote the cessation of tobacco use in youth."

LeFevre said that the task force is looking to future trials to

replicate promising interventions;

examine the effectiveness of specific intervention components and determine the feasibility of specific components in real-world primary care practices;

incorporate longer-term outcomes;

include other forms of tobacco use than cigarettes; and

include more diverse samples of children and adolescents with regard to demographic characteristics, various stages of initiation, and/or readiness to quit.

The AAFP is reviewing the draft recommendations and will update its own 2003 tobacco use and counseling recommendations for children and adolescents after the USPSTF publishes its final conclusions in 2013.